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08.05.2018 | Cornea | Ausgabe 9/2018

Graefe's Archive for Clinical and Experimental Ophthalmology 9/2018

Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty

Zeitschrift:
Graefe's Archive for Clinical and Experimental Ophthalmology > Ausgabe 9/2018
Autoren:
Matthias Fuest, Sharita R. Siregar, Abdelsattar Farrag, Hla Myint Htoon, Donald Tan, Jodhbir S. Mehta
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00417-018-3997-6) contains supplementary material, which is available to authorized users.

Abstract

Aims

To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity.

Methods

Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications.

Results

The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (− 4.8 ± 3.5 D) and cylinder (− 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6–54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up.

Conclusions

DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.

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Zusatzmaterial
Video 1 Technique of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DALK). (MP4 17,947 kb)
417_2018_3997_MOESM1_ESM.mp4
Literatur
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